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I had a brief flirtation with antidepressants as a teenager. Going through a rough period, I went to the local GP, explained how I felt and was dispatched to the pharmacy with a prescription. It took about 15 minutes in all. He said take two a day and you will start to see a difference in two weeks and I did. After taking the medication for two weeks, I was coping so badly with normal life that I went back to him and asked him what to do. During this time, I had not slept well either and I felt in a different dimension. His answer was that these particular drugs don’t fit with me and after gradually coming off, I should try some others and pop a sleeping pill to get a good nights sleep. I never filled that prescription and instead took the advice of an older mentor who introduced me to hiking and exercise. I never really looked back.

Is this a familiar story? Are we really being conned by the so-called ’Big Pharma’ firms who are gleefully peddling their snake oil to the unsuspecting public? Are GP’s and managed care systems being misled about antidepressants in the same way the Sackler family used false information and research to market OxyContin, a drug that lead to one of the biggest addiction scandals the world has ever seen and caused thousands of deaths? If you believe a new report based on research from the University of London, then all of the above is true. The London Times reports the following on the research;

The widespread use of antidepressants is “not grounded in science” because depression is not caused by a chemical imbalance, according to a new study. After analysing decades of previous research, involving tens of thousands of patients with the condition, the team found “no convincing evidence” of a link with serotonin, a neurotransmitter in the brain. The marketing of SSRIs, including Prozac in the 1980s, popularised the idea that depression was caused by a chemical imbalance in the brain, although few experts now agree. Professor Joanna Moncrieff, a consultant psychiatrist who led the study, said this “false belief” had driven a dramatic increase in the prescription of SSRIs since the 1990s.

The Times

The article goes on to state that while depression is not caused by a chemical imbalance, it can be caused by such issues as grief, loss or a downturn in life which could be helped in other ways. Countering evidence in the article from other psychiatrists criticised the research saying that medication is a ’life saver’ for many. Experts agreed that they do not really know why medication works but ’it seems to’ in many cases. The so-called placebo effect was also mentioned.

In an associated article, James Davies, an academic who has long assailed what he sees as the alarming trend of over-diagnosing and over-medicalising mental distress, said that the study didn’t surprise him in the slightest.

Almost a decade ago Davies, reader in medical anthropology and mental health at the University of Roehampton, wrote Cracked: Why Psychiatry Is Doing More Harm than Good, a bestselling attack on psychiatry. In his follow-up, Sedated, he looks at how our mental health sector has continued to expand but consistently fails to make us better. He is especially concerned at how prescriptions have soared while our mental health has not improved. “Here is a study showing what we’ve known for a long time, which is that depression isn’t caused by chemical imbalances,” he says. “This was a piece of mythology, which was very useful for the pharmaceutical industry to deploy to legitimate use of their products: SSRI antidepressants.”

The Times

Of course, all of the above has been countered by other psychiatrists who believe that depression is due to biology and a medical intervention with medication is essential. (Some would argue that they would say that). However, Prof Moncrieff’s study has highlighted an important question. The pills might work but should we be taking them to the extent we are and are there alternatives? Alternatives exist but as a species, we are also very fond of the ’quick fix’ in life and especially where mental health is concerned. As a therapist, I have seen the often painful process of withdrawal when clients are coming off medication. I often describe the US especially as the ’wild west’ of prescription medicine where I have heard accounts of people going to a gynaecologist and coming away with a prescription for depression. I am often alarmed at the lack of after care and checks once medication is given. So there is surely a foundation in the belief that medication is being overprescribed, overused and over-relied on when treating depression generally.

Another article in the Times highlighted some alternatives to medication based on the study’s main findings:

Her view (Prof Moncrieff)— disputed by many psychiatrists — is that depression is not caused by biology. “What’s wrong is that we are viewing it as a medical condition in the first place,” she says. “In my view, depression is not primarily a biological event. It is a human response to things going wrong, or things being wrong in your life. Therefore I think a medical response is inappropriate.

The Times

Intriguing and especially as the NHS in the UK has started to program alternatives to medication by prescribing exercise and peer and professional support. Some health centres in the UK are “socially prescribing” patients to teams who look at their life in a more holistic way, stating that the presenting problem, often used by psychiatrists as a basis for diagnosis and medication is just the tip of a bigger iceberg.

“We need to help people to sort out what’s going wrong in their lives and we need to — as a society — work out why so many people are struggling and so many people feel under so much stress and feel so dissatisfied.”

Professor Joanna Moncrieff

Critics (and supporters of medication) have quickly dismissed the scheme as too expensive and needing too much time to produce results. A bottleneck in the system is that at the time of writing, a patient must be referred to a ’link worker’ in the scheme by a GP, who of course would need to see the advantage of that over medication. GP’s state that they do not have the time to talk to people enough in overcrowded surgeries. One stated that:

“Do we prescribe too many of them? (Medication) Yes, and historically the reason is that when somebody comes to see you, as a doctor, in your ten-minute consultation and says they are very depressed, what options are there? The choices are essentially psychological therapies or antidepressants.” Even before the pandemic, waiting lists for talking therapies were months long, so for many doctors — and patients — there isn’t much choice.

Whatever you believe to be true, Big Pharma has not helped its reputation as a force for good. Questionable research and marketing have drawn blurred lines between consumer benefit and capitalism. The new DSM has increased the number of disorders from 100 to 370. Cynics would state that this development is an increased opportunity to make money. I also know from talking to other therapists that they find it hard to have to find a DSM diagnosis code in order to get paid. I wonder how many people are caught up in the cycle of misdiagnosis and overprescription. I suspect many.

Hopefully this debate will open up new opportunities for help for depression. I am a great believer in mindfulness, leading a productive life including good diet, exercise and sleep. Something I feel anyone can benefit from.